Preparing for Apheresis Procedure: Mononuclear Cell Collection

During an apheresis procedure, blood is removed from the body through tubes and processed by an apheresis machine. This machine separates the different parts of your blood to collect cells that will eventually make your cancer fighting cells (called CAR-T cells). It returns the rest of your blood cells back to your child. Blood is taken out, mixed with saline and returned to your child either by needles placed in the arm’s veins or through a central venous catheter line placed near the heart.

An anticoagulant, or blood thinner, is added during the process to keep the blood from clotting in the machine. The amount of blood outside of your child’s body at any time during the procedure is about one cup.

Your child may have some side effects during the procedure. It is important that you report any of these symptoms to the nurse:

• Discomfort and or minor bruising from the needle sticks or line exit site
• Temporary numbness or tingling around the mouth, in the jaw, fingers
• Sour taste in the mouth
• Muscle cramping, anxiety, nausea, vomiting, or fainting
• Severe muscle cramping and seizures can happen, but are rare

If your child is taking any medicines, these may need to be stopped few days to a week before the procedure. Talk with your doctor or research team.

Have your child:

• Eat calcium-rich foods (like milk, yogurt, and cheese). We may also recommend you give calcium supplements. This will help lessen the side effects from the anticoagulant medicine (citrate) used during the procedure.
• Drink plenty of liquids – at least 6 to 8 glasses a day. It makes it easier to find a vein when it’s puffy and well-hydrated if an IV is placed.

Have your child:

• Eat a good meal right before the procedure. The procedure is best tolerated with food in their stomach.
• Dress in loose clothing and short sleeves that allows easy access to the catheter or their arms (if IV is needed).

If your child is small and does not weigh very much, they may require a blood prime. This is where we add blood from a donor bag of blood to fill the machine and tubing to get your child started. This helps to decrease unwanted side effects such as low blood pressure. A premedication may be given before the blood prime transfusion if there is history of previous reactions to blood products.

• Your child will have heart monitors on their chest and have vitals checked every half hour.
• They will be asked to use the restroom right before the procedure starts as it may take up to 4 to 6 hours. If they need to pee during apheresis, a urinal or portable potty chair (commode) is provided at bedside.
• Blood is drawn for labs before, during and after the procedure using the same line used for apheresis (whether IV or central line).

Your child may require a blood transfusion before, during, or after the procedure. Or sometimes we need a small amount of blood added to the machine (see blood prime above). All donor blood used in transfusion is screened to match your child’s red blood cells. However, anytime donor blood is transfused into another person, there is risk of infection or transfusion reaction.

• Your child can sleep, listen to music, watch TV, or play on an iPad during the procedure.
• If an IV is necessary, arm movements will need to be limited to prevent the IV from coming out.
• We cannot disconnect your child from the machine until the end of the procedure. Your child will not be able to get up and walk around during the collection.
• It’s fine for your child to eat and drink during the procedure. Ask your nurse about the hospital room service menu and how to order.
• Some patients may have side effects such as numbness or tingling around the mouth, nausea, or vomiting during the collection. Alert the nurse if you notice any changes in your child’s well-being or behavior.

• The anticoagulant used during the procedure may put your child at risk for bleeding for up to 4 hours after apheresis. Have your child avoid rough play for this time period.
• Your child may require transfusions after the procedure. A blood count will be obtained to check.
• If IV catheters were placed in the arms, when the machine finishes, the nurse will remove the needles and place a small bandage or gauze on the exit sites.
• Your child can start their regular (light) activity and foods right away.

If an IV was used, leave the bandage on for at least 4 hours. If you see bleeding at the site soaking through the bandage, apply fingertip pressure for 5 minutes and keep the bandage on for an additional 4 hours. Avoid heavy lifting for the rest of the day.

• If a temporary central catheter (in the chest) was used, it will be removed after the procedure by a provider after labs results are in.
• Keep the dressing on for 48 hours (2 days). Replace the dressing if it becomes wet or dirty.
• After 48 hours, you may remove the dressing and shower as usual. No baths or going under water for at least 7 days.

Call if your primary care doctor if your child has any of the following warning signs:

• Fever or chills
• Redness or swelling at line exit site
• Any drainage at line exit site
• Pain
• Bleeding that does not stop after 2 minutes of holding pressure.
• Shortness of breath or difficulty breathing — CALL 911

If your child required a transfusion, call your doctor for the following signs:

• Back pain below the ribs
• Dark or reddish urine
• Yellowing of the skin or eyes (this may be sign of delayed reaction if it happens days or weeks after the transfusion)
• A change in your child’s health that concerns you